Provider Demographics
NPI:1164744306
Name:ZAVADA, PAMELA (LSW, BCBA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ZAVADA
Suffix:
Gender:F
Credentials:LSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 WARWICK LN
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5876
Mailing Address - Country:US
Mailing Address - Phone:815-679-0405
Mailing Address - Fax:
Practice Address - Street 1:381 WARWICK LN
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5876
Practice Address - Country:US
Practice Address - Phone:815-679-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2011-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.012032104100000X
1-10-6791103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker